Healing from sexual violence among young women in South Korea

Reports of sexual violence against young women have been increasing. Due to limited support, young women who experience sexual violence have difficulties in healing, resulting in long-term consequences for individuals and society. We used grounded theory combined with a Photovoice approach to explore young women’s experience of healing from sexual violence. From interviews and Photovoice activities of 29 participants, we identified a social process of healing that included internalizing anger, cutting off connections, reaching a turning point with support, restoring connections, struggling through individual internal processes, and transforming sexual violence into a stepping stone. The process of healing from sexual violence identified in this study shows commonalities as well as cultural and age-specific aspects from experiences of sexual violence among young women. In addition, this theory presented a new perspective on healing that contrasts with the past belief that disclosure is the key to healing.     

Services doing the best they can: service experiences of young adults with type 1 diabetes mellitus in rural Australia

Aims and objectives. To describe the healthcare experiences of young adults with type 1 diabetes who access diabetes services in rural areas of New South Wales, Australia. Background. The incidence of type 1 diabetes in childhood and adolescence is increasing worldwide; internationally, difficulties are encountered in supporting young people during their transition from children to adulthood. Consumers’ experiences and views will be essential to inform service redesign. Design. This was a qualitative exploratory study. Methods. Semistructured telephone interviews were conducted with 26 people aged 18–28 years living rurally, recruited through staff in four regional healthcare centres in 2008. Results. Two key themes were evident: lack of access (comprised of transfer to adult services, access to health professionals and access to up‐to‐date information) and age‐appropriate provision. The impact of place of residence and personal motivation crossed all themes. Participants contrasted unfavourably the seamless care and support received from paediatric outreach services with the shortages in specialist and general practice‐based care and information and practical problems of service fragmentation and lack of coordination experienced as adults. They identified a range of issues including need for ongoing education, age‐appropriate services and support networks related to developing their ability to self‐manage. They valued personal service; online and electronic support was seldom volunteered as an alternative. Conclusion. This was a first view of rural young people’s experiences with adult diabetes services. Reported experiences were in line with previous reports from other settings in that they did not perceive services in this rural area of Australia as meeting their needs; suggestions for service redesign differed. Relevance to clinical practice. New models of age‐appropriate service provision are required, to meet their needs for personal as well as other forms of support, whilst acknowledging the very real resource limitations of these locations.     

The perceptions and aspirations illicit drug users hold toward health care staff and the care they receive

Over the 30 years of conflict, Northern Ireland escaped the worst excess of illegal drug trafficking and usage. However, the recent 'peace dividend' has brought with it an unprecedented rise in the availability and use of illicit drugs. With this, new problems and pressures have been brought to bear on the health service. The literature would suggest that drug users are loathed and feared by health care staff. Staff will also admit to be lacking in the knowledge and skills necessary for the delivery of appropriate support and treatment for this client group. Further, the literature has little to offer on the experiences and aspirations of drug users in relation to their treatment and the staff who care for them. In order to understand the drug users' experiences of health care and health staff, focus group methodology was employed to obtain qualitative data. A total of 20 illicit drug users from across Northern Ireland took part. Supporting the literature, all had experienced 'care' that they felt was filled with judgement, hostility and loathing. They recognized clearly the challenge they pose to health care staff. These findings indicate that there is obvious dissonance between those tasked to care for drug users and drug users themselves, with little respect being shown on either side. Results suggest that action needs to be taken to address the deficits in the knowledge, skills and values of health care professionals in relation to illicit drug users. The findings will be of interest to service providers within and outside the United Kingdom.     

The health of children in foster care.

This qualitative study of school nurses describes what the nurses want to do for school children in foster care, what they are actually doing, and how the school organization affects the provision of care. The study looked at the nurses' practice through the lens of the Social Ecological Model of Health, identified interventions using the Minnesota Public Health Intervention Model, and analyzed the school organization using the Bolman-Deal Model (Bolman & Deal, 1997). A purposive sample of nurses was chosen to participate in interviews, and observations of their work and a survey on the frequency of their interventions was implemented. Interviews were analyzed using a phenomenological approach. Four themes derived from the data included structural barriers to client access, nonrecognition of the broad determinants of health, isolationism, and lack of political power. School nurses are aware of foster children's increased health care needs, yet increased services are not provided as a result of a lack of organizational support.     

Integrative review of the social determinants of health in older adults with multimorbidity

Aim

To examine how the social determinants of health have been considered in conceptualizations of multimorbidity in older adults in the literature and to identify implications for nursing practice, research and healthcare planning and policy.

Background

The common conceptualization of multimorbidity is the presence of multiple chronic conditions where one is not more central than others.

Design

The integrative review methodology of Whittemore and Knafl was employed. The World Health Organization Social Determinants of Health framework was used to determine how the social determinants of health have been considered in conceptualizations of multimorbidity.

Data sources

A search of electronic databases (2000–2015) generated 22 relevant articles, including quantitative and qualitative studies and grey literature reports.

Review methods

A systematic process was used to appraise the quality of the documents, conduct qualitative data analysis procedures of data extraction, coding and theme development, and synthesize conclusions.

Results

Current conceptualizations of multimorbidity provide limited consideration of the complex interplay of multimorbidity with the broader social determinants of health. Gender, education, behaviours and the health system were the most commonly cited determinants. Ethnicity, socioeconomic status/social class and material circumstances received little attention. Most of the dimensions of socioeconomic political context were not discussed.

Conclusion

The predominant conceptualization of multimorbidity focuses on the biomedical dimensions of multimorbidity. Consequently, nursing practice, research and policy informed by this literature could inadvertently sustain the mismatch between the needs of older adults with multimorbidity and the services they receive. Future research to inform a new conceptualization is necessary.     

The impact of interpersonal violence on health care

Interpersonal violence is prevalent in our society. Unfortunately, given the current stressors on individuals, families, and communities, the incidences of child abuse, interpersonal violence, and elder abuse are increasing. The economic impact on health care costs is significant. There are many contributing factors to abuse and they are all public health issues that must be addressed for these abuses to cease. This article describes the indicators of interpersonal violence, and outlines strategies for assessment and prevention.     

The social determinants of health and the patient safety paradigm

This article extends the thesis presented in the paper by Tingle, Gibson and Ferrante (2011) that the patient safety agenda needs to operate within a new paradigm. We will introduce the social determinants of health (SDH) as an emerging discourse in global public health. The SDH advocate social and health equity among nations and individuals, and within countries and communities. It has become a key driver for policy makers, health researchers and public health professionals (Raphael, 2011). This article will demonstrate that the paradigmatic lens of SDH offers the opportunity to develop a more upstream analysis of the patient safety agenda based on health systems.     

Encounters between children's nurses and culturally diverse parents in primary health care

The objective of this study was to analyze the healthcare encounters between nurses and parents of different cultural backgrounds in primary health care. An ethnographic study was carried out using participant observations in health centers and interviews with nurses. Data were analyzed using thematic content analysis and constant comparative method. Four main themes were identified when nurses met parents of other cultural backgrounds: lack of mutual understanding, electronic records hamper the interaction, lack of professionals' cultural awareness and skills, and nurses establish superficial or distant relationships. The concepts of ethnocentrism and cultural imposition are behind these findings, hampering the provision of culturally competent care in primary health services. There were difficulties in obtaining and registering culturally related aspects that influence children's health and development. This was due to e‐records, language barriers, and the lack of cultural awareness and skills in health professionals making the encounters difficult for both nurses and parents. These findings show that there is a clear threat for health equity and safety in primary care if encounters between nurses and parents do not improve to enable nursing care to be tailored to any individual family needs.     

The conundrum of children in the US health care system

One area in which children's rights are rarely considered in the USA is that of autonomy over their bodies. This right is routinely ignored in the arena of health care decision making. Children are routinely excluded from expressing their opinions involving medical decisions that affect them. This article discusses the complex reasons why children's voices are typically not heard in the USA, the consequences of their disempowerment, and the ethical obligations of health care providers to advocate for the rights of children, even in the absence of a legal mandate to do so.     

Unmet needs and health care utilization in young adults with cerebral palsy

Purpose. To gain insight into the unmet needs and utilization of health care of young adults with cerebral palsy (CP) and to explore relations between unmet needs, health care utilization and subject characteristics.

Method. A cross-sectional study was performed in 29 young adults with CP without severe learning disabilities (IQ > 70). Subject characteristics such as age, gender, limb distribution, level of gross motor functioning, level of education and perceived participation and autonomy were measured. Outcome measures were the Southampton Needs Assessment Questionnaire, Impact on Participation and Autonomy and a questionnaire on health care utilization.

Results. Young adults with CP reported unmet needs mostly on information (79%), mobility (66%) and health care (66%). About half of the participants visited a rehabilitation physician (52%) or a physical therapist (55%) in the past year. Participants with lower levels of gross motor functioning were found to have more unmet needs and visited various health care professionals more often than young adults with higher levels of gross motor functioning. However, participants with higher levels of gross motor functioning still reported several unmet needs.

Conclusions. Although young adults with CP frequently receive treatment from health care professionals, they indicate unmet needs with respect to several areas such as information on diagnosis, functional mobility and formal health care. In the treatment of young adults with CP, attention should be paid to these aspects.